一、金宅少妇，宦门女也，素任性，每多胸胁痛及呕吐等证，随调随愈。后于秋
尽时，前证复作，而呕吐更甚，病及两日，甚至厥脱不省如垂绝者。再后延予，至，见数医
环视，佥云汤饮诸药皆不能受，入口即吐，无策可施。一医云∶惟用独参汤，庶几可望其生
耳。余因诊之，见其脉乱数甚，而且烦热躁扰，莫堪名状，意非阳明之火，何以急剧若此。
乃问其欲冷水否？彼即点首，遂与以半钟，惟此不吐，且犹有不足之状，乃复与一钟，稍觉
安静。余因以太清饮投之，而犹有谓此非伤寒，又值秋尽，能堪此乎？余不与辩，及药下咽
，即酣睡半日，不复呕矣。然后以滋阴轻清等剂调理而愈。大都呕吐多属胃寒，而复有火证
若此者，经曰∶诸逆冲上，皆属于火，即此是也。自后凡见呕吐，其有声势涌猛，脉见洪数
，证多烦热者，皆以此法愈之，是又不可不知也。
一、胡宅小儿，年甫三岁，偶因饮食不调，延幼科延医，所用之药，无非清火化滞等剂
，因而更损胃气，反致呕吐溏泄，复加清利，遂致吐蛔，初止数条，渐至数十条，细如灯草
，甚至成团搅结而出，早晚不绝。所下者，亦如之，羸困至极，求治于予。因与温胃饮二三
剂，其虫朝夕不止，其多如故。初不识其何所从来，而神化之速，一至如此。乃翁切恳曰∶
止此一儿，死生在公矣，万望先逐此虫，虫不尽则病日甚，其能生乎。予弗之听，但以前药
倍加人参，仍加附子二三剂，而呕吐渐稀，泻亦随止。泻止后乃以理阴煎、温胃饮出入间
用，十余日而虫渐少，一月余而饮食进，肌肉生，复元如故矣。其翁积诚称谢，因问曰∶小
豚之病诚然危矣，令何以不治虫，不治呕泻，而三者俱愈，可闻教乎？予曰∶公之所畏者，
虫也；予之所畏者，胃气也。且凡逐虫之药，无有不伤胃气者，向使胃气再伤，非惟不能逐
虫，而命必随之矣，其害孰甚。故保生之权，全在知本知末，但使脾胃日强，则拔去化虫之
源，而三病同归一得矣，尚何虫泻之敢横哉。闻者叹服，因附着按于此。
又一王宅少妇，年未二旬，素喜瓜果生冷，因常病心腹疼痛，每发必数日不食；后及二
旬之外，则每发必至吐蛔。初吐尚少，自后日甚日多，每吐必一二十条，每发必旬日不食。
所经诸医，但知攻虫，旋去旋生，百药不效。予为诊视脉证，并察病因，知其伤于生冷，以
致脾胃虚寒，阴湿气聚，故为此证。使不温养脾胃，以杜寒湿化生之源，而但事攻虫，虫去
复生，终无济也，因制温脏丸与之，药未完而病随愈矣。后因病愈，而少年任意，仍耽生果
，旧病复作，再制丸服，乃得全愈。观此二证，如前之小儿，乃因凉药伤脾，所以生虫；后
之女人，乃因生果伤胃，所以生虫，可见阴湿内淫，而脾胃虚寒，是即生虫之由也。故凡治
虫之法，但察其别无疳热等证者，悉当以温补脾胃为主。
一、金家的一位年轻媳妇，是官宦人家的女儿，平时性格任性，经常发生胸胁疼痛和呕吐等症状，经过调理后随即痊愈。后来在秋末时节，之前的病症再次发作，且呕吐更加严重，病情持续了两天，甚至出现四肢厥冷、神志昏迷、气息微弱如同濒死的状态。之后延请我诊治，到达时，看到几位医生围在旁边，都说汤药和其他药物都无法服用，入口即吐，束手无策。一位医生说：“只有使用独参汤，或许还有一线生机。”我于是为她诊脉，发现她的脉搏紊乱且极快，并且伴有烦热躁动，痛苦难以名状，心想如果不是阳明经的火邪，怎么会如此急剧。于是问她是否想喝冷水？她立刻点头同意，于是我给她喝了半钟（量器），只有这冷水没有引起呕吐，而且似乎还不够喝的样子，于是又给她喝了一钟，她稍微觉得安静下来。我于是给她投用太清饮，当时还有人议论说这不是伤寒，又正值秋末，身体能承受这种寒凉药吗？我不与他们争辩，等到药服下后，她便酣睡了半天，不再呕吐了。然后用滋阴轻清的方剂进行调理而痊愈。大多数的呕吐多属于胃寒，但像这样有火证的，正如《内经》所说：“各种向上冲逆的症状，都归属于火”，指的就是这种情况。从此以后，凡是见到呕吐，其声音气势汹涌猛烈，脉象洪大快速，症状多为烦热的，都用这种方法治愈，这也是不可不知道的道理。
二、胡家的小男孩，年仅三岁，偶然因为饮食不规律，请儿科医生诊治，所用的药物无非是清火化滞之类的方剂，因而进一步损伤了胃气，反而导致呕吐和腹泻，后来又加上清热利湿的药物，最终导致吐出蛔虫，起初只吐出几条，逐渐增加到几十条，细得像灯草一样，甚至结成团块搅结着出来，早晚不停。排出的大便也是如此，身体极度消瘦困倦，来找我求治。我给他用了温胃饮两三剂，但虫子早晚仍然不止，数量依然很多。起初我不明白这些虫子从何而来，变化之快竟到了这种地步。孩子的父亲恳切地说：“这是唯一的儿子，生死全在您手中，万望先驱除这些虫子，虫子不尽，病势就会日益加重，还能活命吗？”我没有听从他的要求，只是将前面的药方中加倍加入人参，仍然加入附子，连服二三剂，呕吐逐渐减少，腹泻也随之停止。腹泻停止后，便交替使用理阴煎和温胃饮加减治疗，十几天后虫子逐渐减少，一个多月后进食增加，肌肉生长，恢复如初。孩子的父亲感激地称谢，于是问道：“小孩子的病确实危急，您为什么不治虫，不治呕泻，而这三种病都好了，能告诉我其中的道理吗？”我说：“您所害怕的是虫子；我所害怕的是胃气。而且凡是驱虫的药物，没有不损伤胃气的，假如胃气再受损伤，不仅不能驱虫，性命也必然随之丧失，还有什么比这更大的危害呢？所以保全生命的权变，全在于知道根本与末节，只要使脾胃日渐强壮，就能拔除化生虫子的根源，那么这三种病就同时解决了，哪里还有虫子腹泻敢猖狂的呢？”听到的人感叹佩服，因此附上按语在此。
又一例，王家的一位年轻媳妇，年龄不到二十岁，平时喜欢吃瓜果生冷食物，因此经常患心腹疼痛，每次发作必须好几天不进食；后来过了二十岁，每次发作必定会吐出蛔虫。起初吐得还少，自此后一天比一天多，每次必吐出一二十条，每次发作必定十天不进食。所经过的各位医生，只知道攻杀虫体，虫子刚去掉又生出来，各种药物都不见效。我为她诊视脉证，并考察病因，知道她是因伤于生冷，导致脾胃虚寒，阴湿气聚集，所以产生这种病症。如果不温养脾胃，以杜绝寒湿化生的源头，而只是一味地攻杀虫体，虫子去而复生，终究没有帮助，于是制成温脏丸给她服用，药还没吃完病就好了。后来因为病愈，这位年轻人任意妄为，仍然沉迷于生水果，旧病复发，再次制作丸药服用，才得以完全痊愈。观察这两个病例，像前面那个小男孩，是因为凉药伤了脾，所以生虫；后面的女人，是因为生果伤了胃，所以生虫，可见阴湿内侵，以及脾胃虚寒，就是生虫的原因。所以凡是治疗虫证的方法，只要察看她没有其他疳积发热等证候的，都应当以温补脾胃为主。
1. A young wife in the Jin family, a daughter of an official's household, had a willful nature and frequently suffered from chest and hypochondriac pain accompanied by vomiting, which resolved promptly after treatment. Later, at the end of autumn, these symptoms recurred with more severe vomiting. The illness persisted for two days, progressing to cold extremities, unconsciousness, and a critical state resembling impending death. I was subsequently consulted. Upon arrival, I found several physicians surrounding the patient, all stating that decoctions and other medicines could not be retained; anything taken was vomited immediately, leaving them without recourse. One physician remarked, "Only by using *Dushen Tang* (Single Ginseng Decoction) is there hope for survival." I then examined her pulse and found it chaotic and extremely rapid, accompanied by vexation, heat, and restlessness beyond description. I surmised that unless it was Fire of the Yangming channel, how could it be so acute? I asked if she desired cold water. She nodded immediately. I gave her half a *zhong* (a unit of measure), and this was the only thing she did not vomit; indeed, she seemed to desire more. I then gave her another *zhong*, after which she felt slightly calmer. I then administered *Taiqing Yin* (Supreme Clarity Drink). Others questioned whether this was appropriate since it was not a *Shanghan* (Cold Damage) disease and it was late autumn, asking if her constitution could withstand such cold medicine. I did not argue. After the medicine was swallowed, she slept soundly for half a day, and the vomiting ceased. Subsequently, she recovered after being regulated with light, yin-nourishing formulas. Most vomiting cases belong to Stomach Cold, but here we have a Fire syndrome. As the Classics state: "All upward rushing and counterflow symptoms belong to Fire," which applies exactly to this case. From then on, whenever I encountered vomiting characterized by vigorous and forceful expulsion, a洪数 (Hong-Shu / Surging-Rapid) pulse, and symptoms of vexation and heat, I cured them using this method. This is something one must not fail to know.
2. A three-year-old child in the Hu family accidentally suffered from irregular diet. The pediatrician prescribed medicines primarily for clearing fire and resolving stagnation, which further damaged the Stomach Qi. Consequently, vomiting and loose stools ensued. Additional diuretic and clearing treatments were applied, leading to the expulsion of roundworms (*Ascaris*). Initially, only a few worms were expelled, gradually increasing to dozens, thin as rush grass, sometimes clumping together and emerging continuously day and night. The stool contained similar worms. The child became extremely emaciated and weak, seeking my treatment. I prescribed *Wenwei Yin* (Warm the Stomach Drink) for two or three doses. However, the worms continued to appear morning and evening in large numbers. I initially did not understand their origin or their rapid proliferation. The father pleaded earnestly, "This is our only son; his life depends on you. I implore you to expel these worms first. If the worms are not eliminated, the disease will worsen daily, and he cannot survive." I did not heed his request. Instead, I doubled the amount of Renshen (Ginseng Radix et Rhizoma) in the previous formula and added Fuzi (Aconiti Lateralis Radix Praeparata). After two or three doses, vomiting gradually decreased, and diarrhea stopped. Following the cessation of diarrhea, I alternated between *Liyin Jian* (Nourish Yin Decoction) and *Wenwei Yin* with modifications. Over ten days, the number of worms diminished. After more than a month, appetite returned, muscle mass increased, and health was fully restored. The grateful father asked, "The child's condition was indeed critical. Why did you treat neither the worms nor the vomiting and diarrhea, yet all three conditions resolved? Please instruct me." I replied, "What you fear is the worms; what I fear is the Stomach Qi. Moreover, all vermifuges damage the Stomach Qi. Had the Stomach Qi been further damaged, not only would the worms not have been expelled, but life itself would have been lost. What harm could be greater? Therefore, the key to preserving life lies in understanding the root and the branch. If the Spleen and Stomach are strengthened daily, the source of worm generation is eradicated, and all three diseases are resolved simultaneously. How dare the worms and diarrhea persist?" Those who heard this sighed in admiration and recorded this commentary.
Another case involved a young wife in the Wang family, under twenty years old, who habitually enjoyed melons and raw/cold foods. She frequently suffered from heart and abdominal pain, during which she abstained from food for several days. After turning twenty, each episode was accompanied by vomiting roundworms. Initially, few worms were vomited, but the frequency and quantity increased daily, often expelling ten to twenty worms per episode, accompanied by ten days of fasting. Previous physicians focused solely on attacking the worms; the worms were expelled but regenerated, rendering various medicines ineffective. I examined her pulse and symptoms and investigated the cause, determining that injury from raw/cold foods led to Spleen and Stomach Deficiency-Cold, causing Yin-Dampness to accumulate. Thus, this syndrome arose. Without warming and nourishing the Spleen and Stomach to cut off the source of Cold-Dampness generation, merely attacking the worms would result in their recurrence without benefit. I prepared *Wenzang Wan* (Warm the Viscera Pill) for her. The illness resolved before the medication was finished. Later, due to her youthful indiscretion, she resumed consuming raw fruits, causing a relapse. Taking the pill again led to complete recovery. Observing these two cases: the boy developed worms because cold medicines injured the Spleen; the woman developed worms because raw fruits injured the Stomach. This demonstrates that internal invasion of Yin-Dampness and Spleen-Stomach Deficiency-Cold are the causes of worm generation. Therefore, in treating worm syndromes, provided there are no other signs like Childhood Malnutrition Heat (*Ganre*), the primary approach should always be warming and tonifying the Spleen and Stomach.